Pulmonology Coding Alert
Check on Reporting Critical Care Services on Subsequent Days
Question: If our clinician provides critical care services to a patient and if this service extends on to the next date of service, should I report “99291 and 99292” for the second day of service also or should I just use additional units of 99292? If during the service, our pulmonologist performed additional services like ventilator management or performing an emergency thoracostomy, can these services be reported in addition to the critical care services codes?
Wichita Subscriber
Answer: Critical care codes are time based codes that are reported based on the time your physician spent with the patient providing critical care services, both at bedside and on the unit/floor providing care that is directed towards that patient only. So, you report 99291 (Critical care, evaluation and management of the critically ill or critically injured patient; first 30-74 minutes) for the first 30-74 minutes of service and report +99292 (…each additional 30 minutes [List separately in addition to code for primary service]) for every additional 30 minutes of critical care time spent with the patient providing these services.
Although critical care codes are time based codes, you should remember that this time spent need not be continuous. So, if your clinician spent half hour managing the patient initially, after which he did not provide care to the patient for another hour and then again provided service for another one hour forty minutes, you calculate the total time spent with the patient to report the appropriate critical care codes, which in this case would be 99291 and one unit of 99292 for the total of two hours and ten minutes of critical care.
When critical care services extend onto the second day, you report only the services provided for each calendar day. So, if your clinician provided two hours and ten minutes of critical care services on the first day and then provided another one and half hours of service on the second day, you will have to report one unit of 99291 and two units of 99292 for the first date and report one unit of 99291 and one unit of 99292 for the services provided on the subsequent date.
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